1987, 01-29 Permit App: 87000215 Water SoftenerCO
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.JMBING PERMIT APPLICATION WORKSHEET
.r1D COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(V-4. IProject N /'1/S
.(ame Last First MI
Dills Teresa
Project Address (Street Name & Number)
City
State
Subdivision/Plat Name
U-)Es—rALLEY 2-1.-)0.Assessors
Parcel N
C7541/— 0322
Lot
8
Block /
'L
Plat N
/roe° 'Y
Applicant Same
Address
N. 2017 Laura Rd.
City
Spokane
I State
WA
Zip
99206
Phone
928-9693
Business Phone
Contractor
Address
City
I State
Zip
Phone
Contact
Licenseft
Business Phone
Describe Work
Bar Sink(s)'
Drinking Fountain(s):
Floor Drain(s):
Washing Machine(s):
Dsh Wshr(e):
Garb Diop(e):
Kit Sink(s):
Lndry Tray(s).
Sew Eject(s):
Urinal GI:
Wtr Closet(s):
Lav(s):
Shower(s):
Tub(s):
Bidet(s):
Other: TYPO; Water Softener!
Waste/Grease Interceptor(s):
Sewer Y N Septic/ Health No.:
Electric Water Heater(s):
Drains -Roof:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment. Y N
Lawn Sprinkler System(s), Including backf low device on any one meter:
Vacuum breakers or backflow devices in excess o1 line 16:1-5:
(Or) 5+:
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
Soft Water Service Co.
OWNER OR AGENT DATE